Today, Susan MacFarlene tackles nutrition into the Golden Years. As science and medicine continue to advance, so too does our life expectancy. According to the World Health Organization, the global life expectancy was 72.0 years in 2016; an increase of 5.5 years since the year 2000 (1). And growth in life expectancy is not expected to slow down anytime soon. The number of people over the age of 60 in the year 2025 is projected to reach 1.2 billion; a number with the potential to strain an already over-burdened healthcare system (2). In response, there is an increased effort among heath organizations to help seniors preserve health in order to reduce the risk of disease, maintain functional independence, and achieve optimal well-being.
What health concerns exist for older adults?
One of the most common, yet underrecognized, health issues among seniors is malnutrition. The Academy of Nutrition and Dietetics (4) defines malnutrition as a physical state of unbalanced nutrition, which can be either under or overnutrition. Estimates suggest that 15% of all ambulatory seniors are living with malnutrition (5). Importantly, malnutrition can occur at any weight or body mass index and have a detrimental impact on a person’s functioning and wellness. Factors that may contribute to malnutrition include physical changes – decreased smell and taste, poor dentition, dry mouth, swallowing difficulties, decreased stomach emptying – combined with social isolation, and depression (5).
Several screening tools are available to identify the presence of malnutrition in older adults, such as the ‘Malnutrition Universal Screening Tool (MUST)’ and the ‘Mini Nutritional Assessment®’. These screening tools consider appetite changes, weight loss, mobility, BMI, and psychological distress to quantify a person’s risk of malnutrition.
Another concern among older adults is the development of chronic diseases like type 2 diabetes, cardiovascular disease, arthritis, and COPD, along with the potential side effects from medications used to treat these diseases. Unfortunately, there is a large discrepancy between life expectancy and the number of years someone is expected to live disease-free. For example, although the global life expectancy in 2016 was 72.0 years, the healthy life expectancy – or number of years someone might live free of disease – was only 63.3 years (1). Essentially, this means that we are living longer, but sicker, lives. Thankfully, there are many dietary and lifestyle changes that can be adopted at any age to better manage (and sometimes, even reverse) the disease process.
What are the nutrition needs of older adults?
Our body composition begins to change around age 50, with a slow, progressive loss of muscle mass and an increase in fat mass (6). And because our resting metabolic rate (or energy requirement) is largely influenced by muscle mass, these physical changes translate into a reduced calorie need. However, this change in metabolism is not as significant as many people assume; from age 30-80 years, there is a 15% drop in metabolism, which means that your calorie needs are reduced by ~150-200 calories per day at age 80 years (6). These physical changes highlight the importance of strength-building activities in seniors, which preserve both muscle integrity (as well as metabolism) and bone health.
Vitamins, Minerals & Nutrients
Protein needs among older adults are hotly debated, with many suggesting that a higher requirement is needed given that muscle’s response to protein is less efficient in older age (6). Presently, there is no separate recommendation for protein among older adults (i.e. requirements for all adults are 0.8 g per kg per day; 7), although many experts (including me) recommend a slightly higher intake of 1-1.2 g per kg per day with a focus on meeting essential amino acid requirements (6).
The ability to detect thirst decreases with age and dehydration is a common issue in older adults (which can have a negative effect on kidney health and skin integrity; 6). The World Health Organization recommends 30 mL of water per kg (2.2 lbs) of body weight, with a greater volume being needed for those with malnutrition (6). If remembering to drink enough water is challenging, try setting an alarm to remind you to drink throughout the day, or add low-calorie flavouring to your water, which has been shown to increase water intake.
As we age, our ability to fight oxidative damage declines. Consequently, it’s important to include foods with anti-inflammatory and anti-oxidant properties. One such nutrient is omega 3, or more specifically, DHA and EPA, which are found in algae and animals consuming algae (6). Including these fats, either through supplementation or the ingestion of fatty fish/algae, may protect against cognitive decline, the progression of cardiovascular disease, and arthritis (6).
Most people are not eating enough fibre. According to data from the National Health and Nutrition Examination Survey (NHANES) 2009-2010, the average fibre intake for men and women aged 60+ was 18 and 15 grams per day, respectively (8). This intake is far below minimum requirements set by the Institute of Medicine (IOM) of 30 grams per day for men and 21 grams per day for women aged 50 years and older (8). Not only can lower fibre intake lead to constipation (especially when combined with a low fluid intake and a lack of physical activity), it may have a role in the development of diverticular disease, heart disease, and diabetes (6). The best sources of dietary fibre include: pulses, whole grains, fruit, vegetables, as well as nuts and seeds.
As we age, bone health can be compromised since we begin to lose density (occurring in both females and males) and the absorption of calcium declines (5). The IOM recommends a calcium intake of 1200 mg per day for women over 50 and men over 70 (10). Unless prescribed by a physician, it is best to meet calcium needs through food, rather than supplements.
Most people associate vitamin D – the sunshine vitamin – with bone health. While it’s true that vitamin D is essential for the development and maintenance of strong bones, its role in health goes far beyond bones. Results of epidemiological studies suggest that vitamin D deficiency may play a role in the development of autoimmune disease, heart disease, cancer, type 2 diabetes, and infectious diseases (11). The IOM recommends a vitamin D intake of 600 IU for adults aged 50+ and 800 IU for those over 70 years (12). However, this level of intake may not be enough to achieve an optimal vitamin D status (50 nmol/L) and a higher dose of 2000 IU may be necessary (11). Because there are so few food sources of vitamin D, and the production of vitamin D from UV exposure is extremely variable, vitamin D needs should be met through supplementation.
Deficiency of B12 is common among older adults due to decreased stomach acid production (which is needed to absorb vitamin B12), the presence of atrophic gastritis, use of certain medications (antacids, metformin), and pernicious anemia (5). As such, regular monitoring for vitamin B12 deficiency is important in this population. Routine supplementation of vitamin B12 is recommend for anyone following a vegan, vegetarian, pescatarian, or semi-vegetarian diet.
Zinc plays an important role in wound healing, immunity, appetite regulation, and the prevention of macular degeneration (5). Individuals are advised to meet requirements of this nutrient through food, rather than supplements, since supplementation can interfere with the absorption and regulation of other minerals. For more information on zinc, copper, and the ratio between these two nutrients, check out my previous blog post.
- World Health Organization. Global Health Observatory Data: Life Expectancy. n.d. Available from: http://www.who.int/gho/mortality_burden_disease/life_tables/en/
- United Nations 2013 World Population Aging Report. n.d. Available from: http://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2013.pdf
- Leslie W, Hankey C. Aging, nutritional status and health. Healthcare. 2015;3:648-658. Available from: file:///C:/Users/susan/Downloads/healthcare-03-00648%20(1).pdf
- Wolfram T. What is malnutrition? Eat Right: Academy of Nutrition and Dietetics. 2017 Sept. Available from: https://www.eatright.org/food/nutrition/healthy-eating/what-is-malnutrition
- Alberta Health Services. Nutrition Guidelines Seniors Health Overview (65 years and older). 2013 Feb. Available from: https://www.albertahealthservices.ca/assets/Infofor/hp/if-hp-ed-cdm-ns-4-3-1-seniors-health-overview.pdf
- Mak TN, Caldeira S. The Role of Nutrition in Active and Healthy Ageing- For prevention and treatment of age-related diseases: evidence so far. JRC Science and Policy Reports. 2014. Available from: http://publications.jrc.ec.europa.eu/repository/bitstream/111111111/32095/1/lbna26666enn.pdf
- Institute of Medicine. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington D.C.: The National Academies Press; 2006. Protein and Amino Acids; p 144-155.
- Hoy MK, Goldman JD. Fiber intake of the U.S. population: What We Eat in America, NHANES 2009-2010. Food Surveys Research Group: Dietary Data Brief No. 12. 2014 Sept. Available from: https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/dbrief/12_fiber_intake_0910.pdf
- Institute of Medicine. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington D.C.: The National Academies Press; 2006. Dietary Carbohydrates: Sugars and Starches; p 102-109.
- Institute of Medicine. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Washington D.C.: The National Academies Press; 2006. Calcium; p 286-295.
- Holick MF. Vitamin D: evolutionary, physiological and health perspectives. Curr Drug Targets. 2011 Jan;12(1):4-18. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/20795941.
- Institute of Medicine. DRIs for Calcium and Vitamin D. National Academy of Sciences. 2010 Nov. Available from: http://www.nationalacademies.org/hmd/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/DRI-Values.aspx